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Download MBBS Acute Pancreatitis Lecture PPT

Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Latest Acute Pancreatitis Lecture PPT

This post was last modified on 30 November 2021


PANCREATITIS.

DR. P.C. Mishra,MD.
ACUTEPANCREATITIS.

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? An acute condition presenting with abdominal

pain usually associated with raised

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blood/urine pancreatic enzyme as a result of

pancreatic inflammation.

? Reversible pancreatic parenchymal injury

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associated with inflammation.
ACUTE PANCREATITIS.

? PATHOPHYSIOLOGY?

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? Premature activation of

pancreatic enzymes within the pancreas.

? Anything that injures the acinar cells and impairs

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the secretion of zymogen granules or damages

the duct epithelium and thus delays enzymatic

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secretion , can trigger acute pancreatitis.

? Once cellular injury has been initiated , the

inflammatory process can lead to pancreatic

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oedema, haemorrhage, and eventually necrosis.
ETIOLOGY.

? acute pancreatitis-

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? As an acute inflammatory process of the

pancreas with variable involvement of other regional

tissues or remote organ system.

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? Two major causes are--
? Biliary calculi(50-70%)
? Alcohol abuse (25%).

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? The remaining causes may be idiopathic or rare.
? Approx. 25 % cases of Acute pancreatitis.
? Act by increasing the synthesis of enzymes by

pancreatic acinar cells.

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? Over-sensitization of acini to cholecystokinin.
? SMOKING-
? cigarette smoking is an independent

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risk factor for acute and chronic pancreatitis.
HYPERTRIGLYCERIDEMIA.

? Serum concentration above 1000 mg/dl ppt. Attacks of

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acute pancreatitis.

? A triglyceride level higher than 2000 mg/dl confirm the

diagnosis of acute pancreatitis.

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? Hypercalcemia-

Hypercalcemia of any cause can lead to acute

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pancreatitis.

? Deposition of calcium in the pancreatic duct and calcium

activation of trypsinogen within the pancreatic parenchyma.

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Causes of Acute pancreatitis.

? Gall stone.
? Alcoholism.
? Abdominal trauma.

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? Hyperparathyroidism.
? Hypercalcaemia.
? Autoimmune pancreatitis.
? Viral infection.
Gall stone pancreatitis.

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? Transient blockage of common bile duct--

reflux of bile into pancreatic duct and impair

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flow of normal pancreatic juice ?premature

activation of pancreatic enzymes within duct

system.

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CLINICALLY.

? Presenting with 2 of the following 3 criteria

? Epigastric pain consistent with pancreatitis.

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? Serum amylase or lipase level greater than 3

times the upper limit of normal.

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? Radiologic imaging consistent with pancreatitis(

usually CT or MRI ).
HISTORY TAKING.

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? 1.Abdominal pain-
? Site-Diffuse,upperabdominalpain.
? Onset--sudden.
? Character?Boringpain.

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? Radiation---Radiatetoback.
? Associatedfactor-Nausea,vomiting...
? Timing--Painescalatesinintensityandpeakswithin

10-20minutesofonset.

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? Elevationoftemperatureisoftenisacute

pancreatitis.
Abdominal Examination.

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? 1.Inspection-- abdominal distension.
? 2.Palpation--
? Hepatomegally.
? Tenderness.

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? Cullen sign.(Blue

discoloration around umblicus)

? Gray turner sign. ( Blue red

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purple discoloration around flank).

? Peritoneal sign
? Rigidity and Guarding.

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? Percussion--
? Dullness suggesting ascites.

Auscultaion-

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? ascultate the abdomen for hypoactive

or an absent bowel sound.


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INVESTIGATION.

? Biochemical---

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? Serum Amylase increase 3x than

normal or more than 1000IU/mL.( Peak within

the first 24 hrs after onset of symptom.

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? Serum lipase has longer half life thus more

useful in delayed case.

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? Serum lipase: more sensitive and specific for

pancreatitis than Amylase.
Amylase and Lipase.

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? Elevated serum amylase and Lipase levels in

combination with severe abdominal pain. Often

trigger the initial diagnosis of acute pancreatitis.

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? Serum lipase rises 4 to 8 hrs from the onset of

symptoms and normalise within 7 to 14 days

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after treatment.

? Marked elevation of serum amylase level during

24 hrs.

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? If lipase level is about 2.5 to 3 times that of

Amylase, it is an indication of pancreatitis due to

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Alcohol or gall stone.
Biochemical investigation.

? Serum amylase-
? Levels turn normal after 48-72 hrs even

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with the continuing of pancreatitis, serum lipase should be sent
that remains high for 7-14 days.

? Persistent elevation suggests pseudocyst,

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pancreatic abscess or non pancreatic

cause(intestinal obstruction, mumps,narcotics).

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? Serum lipase- Remains elevated for 7-14 days. It is diagnostic.
Serum Lipase.

? The sensitivity of serum lipase is similar to that

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of serum Amylase and is between 85% to

100%.

? Lipase may have greater specificity for

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pancreatitis than amylase.

? Serum lipase always is elevated on the first

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day of illness and remains elevated longer

than does the serum amylase.
Other laboratory Findings.

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WBC- 15000----30OOO

Leucocytosis
GLUCOSE HIGH

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Hyperglycemia in severe cases.
BUN MAY BE ELEVATED

SERUM CALCIUM MAY BE LOW IN 25% OF CASES.

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AST,BILIRUBIN,ALP ARE TRANSIENTLY ELEVATED,ALBUMIN IS LOW IN

10% OF CASES AND INDICATE SEVERE PANCREATITIS
ELEVATED LDH SUGGEST POOR PROGNOSIS

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and indicate biliary tract disease.
Assesment of C-reactive Good indicator of progress.

ABG shows HYPOXIA.
Other cause of increased serum

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Amylase.

? Renal failure.
? Liver cirrhosis.

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? Peritonitis.
? Ruptured ectopic pregnancy.
? Salivary gland inflammation(parotitis).
other blood test.

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FULL BLOOD COUNT

Elevated Leucocyte count for Ranson's

criteria and to predict prognosis.

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LFT

To asses cause of pancreatitis/obstructive

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jaundice.

Random blood glucose

Damage to beta cells interferes with insulin

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production causing Hyperglycemia( in severe

cases).

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Serum calcium

Hypocalcaemia suggest saponification.
Ranson score

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predicting the severity of acute pancreatitis.

? At admission
. age in years > 55
? WBC count > 16000 cells/mm3.

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? Blood glucose > 200 mg/dl
? Serum AST > 250 IU/L
? Serum LDH > 350 IU/L
? At 48 hrs
? Calcium- < 8 mg/dl

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? Hypoxia (po2 < 60mmHg)
? Increased BUN
IMAGING ?ULTRASOUND.

? USG should be performed within 24 hrs in all

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patient.

? To detect--- Gallstones.
? To rule out-- Acute Cholecystitis.

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? To determine whether the common bile duct

is dilated.

? To evaluate change on pancreas i.e. Edema.

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Mass in pancreas.
CT SCAN.

? Not neccessary for all patients.

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? May reveal pseudocyst or

abscess.(complication of acute pancreatitis).

? CT Findings--

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? significant swelling and

inflammation of the pancreas.
Management Acute pancreatitis.

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? Mild Acute pancreatitis--
? 1.Nill by mouth.
? 2.Fluid resuscitation-4 pint.
? 3.Analgesia-IM Tramal 50mg TDS.
? 4.Treat underlying cause.

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? 5. NO role of antibiotic.
Severe Acute Pancreatitis.

? Admission to ICU.
? Oxygen supplementation.

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? Analgesia.
? Aggressive fluid rehydration.
? Monitor vital sign.
? Monitor haematological and biochemical

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parameters.

? Nasogastric drainage.
? Antibiotic prophylaxis--imipenem, cefuroxime.
CASE 1.

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? 56-years-old obese man who is in cardio-

respiratory distress. While reviewing the

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patients record you see that he has a four-yrs

h/o alcohol abuse and he was admitted to the

hospital via the emergency room 36 hrs

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previously with a two day h/o Epigastric pain

and vomiting.........
On admission vital sign..

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? Blood pressure-------95/30
? Pulse rate -------110/min
? Respiratory rate -----28 breath/min.
? temp. ------38.6

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? Abdomen was distended and diffusely tender.
? No Bowel sound were heard.
Laboratory data included:

? WBC count----18,000/ml

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? Blood glucose---220 mg/dl
? Calcium -------- 7 mg/dl
? Creatinine -----2 mg/dl
? LDH -----980 IU/l
? CRP ------15 mg/dl

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? Amylase ---180 IU/l
? Lipase 1540 IU/l
? The serum was Lipemic.